Therapeutic strategy for an obese patient

[Therapeutic strategy for an obese patient]

A treatment stategy can only be based on a case to case evalutation of each obese patient. More than with any other current pathology, treatment will have to be tailor-made despie a rough outline being made of the treatments that will follow.

>> The first step is a thorough evaluation of the patient's medical history (illnesses, any surgery they may have undergone), treatments already tried, eating habits +++, behaviour and psychological profiles, physical activities and hobbies, family and professional surroundings. A strategy is then devised for each case.
What needs to be understood from the start is that any form of treatment of obesity needs to be undertaken with the long-term in view. Obese patients sometimes find this hard to accept as they are desperate to find a 'miracle treatment'. Long-term effectiveness is, however, the only guarantee of success. The treatment programme can be set up as a gradual succession of therapies, the choice of which will depend on the seriousness of the case and the results obtained from previous treatments.

>> First, the patient and the doctor must agree on weight loss objective. This must be reasonable and adapted to the patient, that is to say, it must be realistic. This is where a lot of the problems arise, between the patient who wishes to lose 'all excess weight' as fast as possible, and the doctor who, based on his previous experience and on the available literature, knows that only realistic objectives can be met. It is important to realise that a loss of only 10% excess weight can significantly improve complications or morbidities linked to overweight, such as diabetes or hypertension.

>> The second form of treatment is drug therapy. There are many treatments on offer but these can be divided into two groups : those that treat complications linked to obesity and those that treat the obesity itself. The first type include the anti-diabetic and anti-cholesterol drugs. The second type are the appetite suppressors and those that modify fat absorption.

>> Gastric surgery offers the third type of treatment. Surgery is only available to those people who have failed with all other treatments and to the severely obese patients (so-called morbidly obese, with a BMI above 40 kg/m2, or 35 kg/m2 with co-morbidities linked to the obese state). The intra-gastric balloon is a more moderate alternative as it is less traumatic than surgery, but the objectives are less impressive with regard to weight loss. Plastic and reconstructive surgery should also be mentioned here, although they are explained in a section of their own.

>> Whatever the treatment envisaged, it is only worthwhile as long as the medical and nutritional follow-up is correct. No treatment, no drug (whether it be a miracle drug or not) can ever replace this aspect of the treatment, the absence of which almost inevitably leads to failure.

>> Finally, it is important to talk about preventative treatment, which should mainly be taken on board by the public authorities. Although this aspect of treatment is often overlooked, it is certainly one of the most promising grounds for future success. It will be the object of a special chapter.